RESUMO
BACKGROUND: Although the decreased incidence of gastric cancer, nevertheless many surgical questions are topical, especially the entity of resection and the extent of lymph node dissection. METHODS: We analyzed retrospectively 38 patients operated for gastric adenocarcinoma in our Surgical Division from January 1997 to December 2001. We excluded cancers of cardia and gastroesophageal junction. We evaluated gastric site, macroscopic and microscopic aspect, TNM staging and grading of gastric cancer (UICC 1997), surgical treatment, postoperative complications and survival, in order to identify the rationale surgical approach to gastric cancer in a suburban hospital. RESULTS: Most of patients affected by gastric cancer were older than 60 years (28/38=73.68%). The cancer was prevalently localized in the antral-pyloric region (21/38=55.27%), in the ulcerated form (27/38=71.05%) and differentiated as intestinal subtype (21/38=55.27%). Regarding the UICC staging we found an almost unvarying distribution, but most of cancers were at stage IV (12/38=31.58%). In 71.05% of cases (27/38) a radical operation was feasible. The most performed operation was a total gastrectomy (19/27=70.37%). We performed a D1 dissection in 85.18% of radical operations (23/27). In the resective surgery we reconstructed the intestinal continuity by a mechanical circular stapler Roux en Y anastomosis. CONCLUSIONS: When possible we perform a total gastrectomy. D1 is our standard lymph node dissection, awaiting a defined D2 role in gastric cancer surgery. In the resective surgery we reconstruct the intestinal continuity by a mechanical circular stapler Roux en Y anastomosis. Morbidity was 10.5% (4/38) and mortality was 7.89% (3/38). Old age and pre-existing pathologies have an important role on surgical outcome. Prognosis of advanced gastric cancer is poor, despite a resective surgical treatment. We emphasize the importance of prevention and early diagnosis as fundamental steps of the oncological gastric surgery.
RESUMO
Stapling instruments are being currently used for digestive or colorectal anastomoses with definite advantages. The authors report their initial clinical experience about BAR utilization to restore intestinal continuity after upper digestive and colorectal resections. The authors have been carried out 20 anastomoses on 18 patients: 11 males and 7 females. Eleven (61.1%) of them were affected with malignant neoplasms and in 9 cases were performed an urgency procedure. The colorectal and jejunal-jejunal anastomoses were performed, respectively, in 8 cases; gastric-jejunal and ileo-colic anastomoses, respectively, in 2. The satisfactory results obtained seem to demonstrate that the biofragmentable anastomotic ring constitutes a "safe" method of bowel junction of the whole digestive apparatus.